胸部不同切口治疗小儿常见先天性心脏病的比较

Comparison of different thoracic incision approaches for congenital heart disease in children

目的 比较胸部不同切口治疗小儿常见先天性心脏病的临床结果。 方法 回顾分析 1999年 1月至2 0 0 1年 12月采用胸部不同切口治疗小儿常见先天性心脏病 16 6 9例 ,并根据胸部不同切口分成正中胸骨切口组( Med组 ) ,胸骨下段小切口组 ( Pt组 )和胸部右侧切口组 ( Rat组 ) ,其中行房间隔缺损 ( ASD)修补术 2 4 5例 ,室间隔缺损 ( VSD)修补术 10 0 5例 ,法洛四联症 ( TOF)根治术 4 19例。 结果 ASD修补术中 ,Rat组肺部并发症的发生率高于 Med组和 Pt组 ( P<0 .0 5 ) ;VSD修补术中 ,Rat组术前肺动脉高压的比率低于 Med组和 Pt组 ( P<0 .0 5 ) ,而术后肺部并发症的发生率则高于 Med组和 Pt组 ( P<0 .0 5 ) ;TOF根治术中 ,Med组术前血红蛋白浓度、动脉血氧饱和度分别高于及低于 Rat组和 Pt组 ( P<0 .0 5 ) ,术中跨肺动脉瓣环补片比率却高于 Rat组和 Pt组 ( P<0 .0 5 )。 结论 手术切口的选择应当保证心内畸形的矫正 ,最大限度地减少手术并发症 ,保证患者的安全。

Objective To compare the clinical results of different thoracic incision approaches for congenital heart disease in children. Methods Retrospective analyses of the clinical results of different thoracic incision approaches for 1 669 children with congenital heart disease was performed. All patients were divided into median sternotomy group(Med group), right thoracotomy group (Rat group),and lower partial median sternotomy group (Pt group) according to different thoracic incision. Two hundred and forty five children underwent atrial septal defect(ASD) repair, 1 005 children underwent ventricular septal defect(VSD) repair and 419 children underwent tetralogy of Fallot(TOF) correct repair from Jan. 1999 to Dec. 2001. Results In ASD repair the incidence of pulmonary complications after operation in the Rat group was significantly higher than that in Med group and Pt group ( P <0 05). The percentage of pulmonary hypertension before operation in Med group was significantly greater than that in the Rat group and Pt group ( P <0 05), but the incidence of pulmonary complications in Rat group was significantly higher than that in the Med group and Pt group in children with VSD( P <0 05). The concentration of hemoglobin , the oxygen saturation and the percentage of transannular patch in Med group were significantly higher, lower and greater respectively than those in the Pt group and in Rat group in children with TOF( P <0 05). Conclusion The approaches to be selected should guarantee to correct the cardiac anomaly satisfactorily, reduce the postoperative complications maximally and ensure success of their operations.